with Michael Dansinger, MD

This blog has been retired. We appreciate all the wisdom and support Dr. Dansinger has brought to the WebMD community.

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Chocolate is one of the world’s most prized flavor sensations, and most people who are interested in healthy eating have a vague notion that chocolate might have health benefits. For example, this WebMD article published a few weeks ago reports on the combined results of 21 studies with 2,575 participants showing that cocoa consumption is associated with decreased blood pressure, improved blood vessel health, improvement in cholesterol levels, and improvements in diabetes risk factors such as insulin resistance.

Unfortunately, the role of chocolate in disease prevention has proven to be complicated and controversial from both medical and ethical standpoints.

From a medical standpoint, chocolate appears to be a “mixed bag”. A bar of dark chocolate contains a complex mixture of sugar, fat, cocoa, and other flavor enhancers. The sugar content is lower in dark chocolate than in milk chocolate, however it’s presence certainly offsets (either partially or fully) any potential health benefits of chocolate. We don’t actually know whether eating more dark chocolate is favorable for heart disease or diabetes or longevity, compared to eating less of it. The fat in chocolate is highly saturated, which is concerning as a potential accelerator of heart disease and atherosclerosis. However, much of the saturated fat is comprised of stearic acid, which does not appear to adversely affect cholesterol levels compared to other more common types of saturated fat. Still, fat is high in calories and contributes substantially to chocolate’s high caloric density. It is hard to maintain a healthy weight or battle obesity when eating enough chocolate to potentially achieve health benefits from it.

Any health benefits of chocolate certainly come from the cocoa component. Cocoa contains “polyphenolic flavanoids” which are antioxidants with the potential to improve multiple heart disease risk factors. Much work is underway to better understand how these compounds work on a cellular level. In any case, most of the studies that indicate improvements in heart disease risk factors are inconclusive because they are either short-term trials that just look at risk factors rather than actual disease rates, or because they are observational studies that cannot draw conclusions about cause and effect. The matter is further complicated by the fact that many of the studies use special chocolate products that are uncharacteristically high in cocoa content and/or low in sugar, and/or sponsored by companies that sell chocolate.

My guess is that cocoa is actually beneficial, but the sugar and fat present in dark chocolate bars entirely offsets those benefits such that dark chocolate bars are “health neutral” rather than beneficial. The logical way to leverage the potential health benefits of cocoa would be to find ways to incorporate significant amounts of unsweetened cocoa powder into foods and/or beverages that do not contain excess sugar or fat. For example, I use my blender to make home-made shakes containing frozen banana, cocoa powder, a few almonds (or almond milk) and a little stevia.

Unfortunately, much of the chocolate and cocoa available is produced by African children working under conditions that would be considered unethical and illegal in most Western countries. Some of the chocolate is likely produced by slave labor and efforts are underway to address this serious political problem. Fortunately, it is possible to buy cocoa and chocolate that is certified as conforming to our usual ethical standards. Trader Joe’s and Whole Foods would be good places to find such products.

In the final analysis, our love affair with chocolate gets mixed reviews on multiple levels. Like many of life’s potential treasures, “the devil is in the details”. If we’re smart about it, we can probably do a much better job learning (on multiple levels) how to properly harvest and harness the healthy aspects of this wonderful gift from “mother nature”.

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Nationally recognized authority on dietary and lifestyle counseling for weight loss and disease prevention. Director of the Diabetes Reversal Program at Tufts Medical Center in Boston, assistant professor at Tufts University School of Medicine, Nutrition Consultant for NBC's "The Biggest Loser", and Lifestyle Director at Boston Heart Diagnostics.

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